结膜瓣遮盖术治疗29例难治性角膜溃疡

Conjunctival flap surgery in treating 29 refractory corneal ulcer cases

目的观察结膜瓣遮盖术治疗29例难治性角膜溃疡的临床效果。方法回顾分析2013年1月至2017年12月在我院行结膜瓣遮盖术治疗的29例(29眼)难治性角膜溃疡患者。其中真菌性角膜溃疡8例,单纯疱疹性角膜溃疡5例,细菌性角膜溃疡9例,外伤后继发角膜溃疡者2例,不明原因者5例。所有角膜溃疡患者中伴穿孔者3眼。对上述患者行病灶清除+结膜瓣遮盖术治疗,术后针对原发病进一步进行药物治疗。结果 28眼经过一次手术后,角膜溃疡愈合;1眼术后2周时结膜瓣溶解脱落,出现前房积脓,再次行结膜瓣遮盖术,但最终未保住眼球。该手术方法治疗角膜溃疡有效率达96%。本组病例中,28眼通过结膜瓣遮盖术达到治愈角膜溃疡,保存眼球的目的。结论对于药物治疗无效的难治性角膜溃疡,结膜瓣遮盖术仍是有效的治疗方法,可以促进溃疡愈合,保存眼球,尤其对于不能开展角膜移植的基层医院具有重要的临床应用价值。

Objective To study the clinical effect of conjunctival flap covering surgery in the treatment of 29 refractory corneal ulcer cases. Methods Twenty-nine patients （29 eyes） with refractory corneal ulcers undergoing conjunctival flap covering in our hospital between January 2013 and December 2017 were retrospectively analyzed. Among them, 8 patients suffered from fungal corneal ulcers, 5 patients with herpes simplex keratitis, 9 patients with bacteria corneal ulcers, 2 patients with traumatic corneal ulcers, and 5 patients with no clear causes. In all the patients, 3 eyes had complicated with perforation. All patients underwent ulcer debridement and conjunctival flap covering. Postoperatively, primary lesions were treated with further drug therapy. Results After primary surgery, 28 eyes healed. One eye presented with dissolving and exfoliation of conjunctival flap and hypopyon 2 weeks after surgery. Therefore, the eye was treated with secondary conjunctival flap covering. However, the eye was eventually blind. The effective rate of this method in the treatment of corneal ulcers reached 96%. In the patients, 28 eyes with corneal ulcers healed after conjunctival flap covering, and the eyeballs were recovered. Conclusions For refractory corneal ulcers showing no improvement in drug therapy, conjunctival flap covering is still an effective therapeutic method, which can promote ulcer healing and preserve eyeballs. Especially for grass-roots hospitals which can not carry out corneal transplantation, it is of important value in clinical application.